# Ketamine, Psychedelics, and Psychotherapy: Reframing, Redefining, Renaming Treatment Models

## TL;DR

This paper clarifies the confusing landscape of ketamine and psychedelic treatments by proposing new definitions to better understand their roles in mental health therapies.

## Contribution

The paper introduces three new definitions to distinguish how psychedelics and ketamine are used in treatment, either alone or with psychotherapy.

## Key findings

- Current studies often fail to clearly define the role of psychotherapy in psychedelic and ketamine treatments.
- There is a lack of standard definitions for how these drugs interact with psychotherapeutic interventions.
- The proposed definitions aim to improve clarity in research, regulation, and patient care.

## Abstract

There has been a renewed interest in the use of various psychedelic agents as potential therapies for multiple psychiatric conditions, including post-traumatic stress disorder (PTSD), major depressive disorder (MDD), generalized anxiety disorder (GAD), to name a few. This follows the recent accumulation of evidence for ketamine pharmacotherapy and a rapid proliferation of clinics/programs offering a variety of ketamine based treatments. A quick glance at the existing evidence, however, reveals a confusing scenario for patients, healthcare providers, and regulators. Overall, there are no standard definitions of what constitutes a psychotherapeutic intervention within a psychedelic-based or a ketamine-based treatment. More specifically, studies have not always distinguished between using a well-known, manualized psychotherapy, providing psychoeducation and psychological support, or providing a therapy specifically to integrate the drug experience in psychedelic trials. Also, it is difficult to determine the role of the psychedelic agent as a stand-alone treatment, and the relative importance (if any) of the psychedelic experience for the desired therapeutic effect. In this perspective, we discuss the evolving landscape of psychedelic-based and ketamine-based treatments, highlighting different therapeutic models, their methodologies, and the need for clearer definitions and rigorous clinical trials. The document proposes three new definitions to improve clarity in evaluating the effects of these agents and the role of psychotherapies. We suggest language that will distinguish: (1) when the drug is used for its pharmacologic effects as a stand-alone treatment, without requiring the psychedelic experience or combined psychotherapy; (2) when the treatment requires the acute psychological effects of the drug to assist psychotherapy and (3) When ketamine or a psychedelic agent is used in combination with a structured, manualized psychotherapy that could be implemented even in the absence of these agents. We hope that this new terminology and definitions will help distinguish the various therapeutic roles of these agents (as stand-alone treatments or in combination with psychotherapies), and facilitate study designs, regulatory pathways, and more informed patient care.

Ketamine, Psychedelics, and Psychotherapy: Understanding treatment models to better inform practice

Plain Language Summary

The use of psychedelics to improve symptoms of post-traumatic stress disorder (PTSD), major depressive disorder (MDD), and generalized anxiety disorder (GAD has gained significant attention lately, following the rapid proliferation of clinics/programs offering ketamine-based therapies.

However, it can be confusing for patients, healthcare workers, and regulators to understand what all these treatments actually involve. There are no standard definitions of what a psychotherapeutic intervention involving psychedelics or ketamine truly means.

More specifically, studies often haven't clearly separated the use of well-established, manualized psychotherapies from simply offering psychological support or psychoeducation during psychedelic trials. It can also be challenging to understand the role of the psychedelic itself as a standalone treatment, as well as how much the psychedelic experience contributes to the positive therapeutic outcomes, if at all.

Here, we explore the changing world of psychedelic- and ketamine-based treatments, highlighting various therapeutic approaches, their methods, and the importance of clearer definitions and thorough clinical trials. The document introduces three new definitions to help clarify how these agents are evaluated and their relationship with psychotherapies. We suggest language that clearly distinguishes: 1) when the drug is used for its pharmacologic effects alone, without needing the psychedelic experience or combined therapy; 2) when the drug's immediate psychological effects are used to support therapy; and 3) when ketamine or another psychedelic is used alongside a structured, manualized psychotherapy that can be offered even without these agents.

We hope that this new terminology and definitions will help distinguish the various therapeutic roles of these agents (as stand-alone treatments or in combination with psychotherapies), and facilitate study designs, regulatory pathways, and more informed patient care.